Videolaryngostroboscopy to Therapy Translational Framework: Bridging Laryngeal Imaging and Voice Therapy via Biomechanical Inference.

OBJECTIVES: A gap separates videolaryngostroboscopy (VLS) findings from therapy decisions in voice care. This article proposes a translational framework that converts VLS findings into biomechanically informed therapeutic targets and candidate voice therapy techniques, whether the examination is reported by an otolaryngologist or performed by the speech-language pathologist.

STUDY DESIGN: Clinical framework development with translation tables and synthetic illustrative cases.

METHODS: The framework integrates the 2018 American Academy of Otolaryngology-Head and Neck Surgery Foundation guideline, which recommends laryngoscopy before voice therapy; the 2023 European Laryngological Society and Union of European Phoniatricians core dataset; and classical vocal fold biomechanics, complemented where stated by the author's Unified Theory of Phonation. Two published high-speed videoendoscopy biomarkers, the Empirical Distribution of Glottal Edges and the Laryngovibrogram, are adopted, and one original index, the Stiffness/Pliability Index, is proposed. Evidence is graded with Oxford Centre for Evidence-Based Medicine levels.

RESULTS: A translation matrix links eight VLS findings to therapeutic targets and five techniques: semi-occluded vocal tract exercises, resonant voice therapy, vocal function exercises, manual circumlaryngeal therapy, and easy phonation. Five glottic closure patterns are mapped to distinct biomechanical inferences. A biomechanical inference triad structures bedside reasoning, a decision algorithm with an explicit safety gate is proposed, and three synthetic cases (nodules, unilateral paralysis, scar) illustrate its use. Biomechanical Reference Values are offered as provisional tracking thresholds, explicitly not validated minimal clinically important differences.

CONCLUSIONS: The framework gives clinicians a structured, shared language for moving from VLS findings to therapy plans. All translations are clinical inferences, not direct measurements of impact force or tissue stiffness; its indices, thresholds, and mappings are hypotheses that require reliability testing and prospective validation before routine clinical use.